THE ASSOCIATION OF ORPHAN AND VULNERABLE CHILD (OVC) PRIMARY CAREGIVING, HOUSEHOLD WEALTH, AND FEMALE AUTONOMY ON WOMEN'S BODY MASS INDEX IN NAMIBIA, SWAZILAND AND ZAMBIA

Background: This dissertation investigates factors associated with orphan and vulnerable child (OVC) caregivers' body mass index (BMI) in Namibia, Swaziland and Zambia. Methods: Secondary analyses were performed using cross-sectional data from Demographic Health Surveys conducted in 2006 and 2007. Manuscript 1 included de facto women from Namibia (n=6,638), Swaziland (n=3,285), and Zambia (n=4,497). Manuscript 2 included de jure women from Namibia (n=6,305), Swaziland (n=2,786), and Zambia (n=4,389). Manuscript 3 included married de jure women from Namibia (n=2,633), Swaziland (n=1,395), and Zambia (n=2,920). Statistical analyses using data from 20-49 year old women included weighted marginal means, logistic regression, and Sobel and Goodman tests. Results: Manuscript 1. OVC caregivers' overweight prevalence ranged from 26.98% (Namibia) to 61.3% (Swaziland). Namibian OVC caregivers were less likely to be overweight than non-OVC caregivers and non-caregivers not living with OVC. Swazi and Zambian OVC caregivers were more likely to be overweight than non-caregivers. In Namibia, women's age modified the effect of the association between OVC caregiving and overweight status. Manuscript 2. Namibian and Swazi OVC caregivers had lower Absolute Wealth Index (AWI) mean scores than non-OVC caregivers and non-caregivers. In Zambia, OVC caregivers had a lower mean AWI score than non-caregivers living with an OVC but a higher mean AWI score than non-OVC caregivers. In all countries, even small increases in household wealth (e.g., being a poorer women - 2 to 3 AWI items) were associated with higher odds for being overweight regardless of women's caregiving status. Manuscript 3. Women's educational attainment increased the odds for being overweight in Swaziland and Zambia, and decreased the odds for being underweight in Namibia. Decision-making autonomy mediated the association between AWI and OVC caregivers' BMI in Zambia (Z=2.13, p=0.03). Conclusions. As Africa is experiencing a nutritional and HIV/AIDS transition, overweight problems among OVC caregivers has emerged and should be addressed. These findings support the World Health Organization's recommendations that African countries should focus on addressing infectious diseases as well as the emergence of chronic diseases. Some African public health systems and OVC programs may face a new overweight epidemic alongside existing ones such as HIV/AIDS, tuberculosis, and malaria

Overweight status of the primary caregivers of orphan and vulnerable children in 3 Southern African countries: a cross sectional study

Background: Africa is facing a nutritional transition where underweight and overweight coexist. Although the majority of programs for orphan and vulnerable children (OVC) focus on undernourishment, the association between OVC primary caregiving and the caregivers\u27 overweight status remains unclear. We investigated the association between OVC primary caregiving status with women\u27s overweight status in Namibia, Swaziland and Zambia. Methods: Demographic Health Survey (DHS) cross-sectional data collected during 2006-2007 were analyzed using weighted marginal means and logistic regressions. We analyzed data from 20-49 year old women in Namibia (N 6638), Swaziland (N 2875), and Zambia (N 4497.) Results: The overweight prevalence of the primary caregivers of OVC ranged from 27.0 % (Namibia) to 61.3 % (Swaziland). In Namibia, OVC primary caregivers were just as likely or even less likely to be overweight than other primary caregivers. In Swaziland and Zambia, OVC primary caregivers were just as likely or more likely to be overweight than other primary caregivers. In Swaziland and Zambia, OVC primary caregivers were more likely to be overweight than non-primary caregivers living with OVC (Swaziland AOR = 1.56, Zambia AOR = 2.62) and non-primary caregivers not living with OVC (Swaziland AOR = 1.92, Zambia AOR = 1.94). Namibian OVC caregivers were less likely to be overweight than non-caregivers not living with an OVC only in certain age groups (21-29 and 41-49 years old). Conclusions: African public health systems/OVC programs may face an overweight epidemic alongside existing HIV/AIDS, tuberculosis and malaria epidemics. Future studies/interventions to curb overweight should consider OVC caregiving status and address country-level differences

A Brief Report: Lessons Learned and Preliminary Findings of Progreso en Salud, an HIV Risk Reduction Intervention for Latina Seasonal Farmworkers

Throughout the past decade, HIV rates in Florida?particularly South Florida, where many Latina seasonal farmworkers reside and work?have ranked among the highest in the nation. In this brief report, we delineate important lessons learned and preliminary findings from the implementation of the HIV prevention intervention Progreso en Salud (Progress in Health). Among the 114 Latina seasonal farmworker participants, there were significant increases from baseline to 6-month follow-up in the percentages of overall condom use, HIV testing, HIV/AIDS-related communications with friends, HIV knowledge, condom use self-efficacy, and correct use of condoms. Lessons learned from this study can be used to inform future HIV intervention strategies to improve the adoption and maintenance of HIV risk reduction behaviors among high-risk Latina seasonal workers and other high-risk underserved populations. Future research is needed to support our findings

Sociocultural Determinants of Risky Sexual Behaviors among Adult Latinas: A Longitudinal Study of a Community-Based Sample

Few studies have examined the sociocultural determinants of risky sexual behavior trajectories among adult Latinas. To longitudinally examine the link between sociocultural determinants of risky sexual behaviors, we followed a sample of adult Latina mother-daughter dyads (n = 267) across a 10-year span through four waves of data collection. The present study investigates how risky sexual behavior (operationalized as sex under the influence of alcohol or other drugs, sex without a condom, or multiple sex partners) is affected by: (a) socioeconomic conditions; (b) mental health; (c) medical health; (d) acculturation to U.S. culture; (e) interpersonal support; (f) relationship stress; (g) mother-daughter attachment; (h) intimate partner violence; (i) religious involvement; and (j) criminal justice involvement. Results indicate the following factors are negatively associated with risky sexual behavior: drug and alcohol use, treating a physical problem with prescription drugs, religious involvement, and mother?daughter attachment. The following factors are positively associated with risky sexual behavior: higher number of mental health symptoms, being U.S.-born, and criminal justice involvement. We discuss implications for the future development of culturally relevant interventions based on the study findings

Validation of a susceptibility, benefits, and barrier scale for mammography screening among Peruvian women: a cross-sectional study

<p>Abstract</p> <p>Background</p> <p>Perceived beliefs about breast cancer and breast cancer screening are important predictors for mammography utilization. This study adapted and validated the Champion's scale in Peru. This scale measures perceived susceptibility for breast cancer and perceived benefits and barriers for mammography.</p> <p>Methods</p> <p>A cross-sectional study was conducted among women ages 40 to 65 attending outpatient gynecology services in a public hospital in Peru. A group of experts developed and pre-tested a Spanish version of the Champion's scale to assess its comprehensibility (N = 20). Factor analysis, internal consistency, and test-retest reliability analyses were performed (N = 285). Concurrent validity compared scores from participants who had a mammogram and those who did not have it in the previous 15 months. T-test and multiple regression analysis adjusting for socio-demographic factors, mammography knowledge and other preventive behaviors were performed.</p> <p>Results</p> <p>The construct validity and reliability were optimal. Cronbach-Alpha coefficients were 0.75 (susceptibility), 0.72 (benefits) and 0.86 (barriers). Concurrent validity analysis showed an association between barriers and mammography screening use in bivariate (22.3 ± 6.7 vs. 30.2 ± 7.6; p < 0.001) and multiple regression analysis (OR = 0.28, 95% CI = 0.18-0.43). Ages 50-60 years (OR = 2.35, 95% CI = 1.19-4.65), history of prior Papanicolaou test (OR = 3.69, 95% CI = 1.84-7.40), and knowledge about breast cancer and mammography (OR = 3.69, 95% CI = 1.84-7.40) were also independently associated with mammography screening use.</p> <p>Conclusion</p> <p>Concurrent validity analysis showed that the Champion's scale has important limitations for assessing perceived susceptibility for breast cancer and perceived benefits for mammography among Peruvian women. There is still a need for developing valid and reliable instruments for measuring perceived beliefs about breast cancer and mammography screening among Peruvian women.</p

Progreso en Salud: Findings from Two Adapted Social Network HIV Risk Reduction Interventions for Latina Seasonal Workers

Background: Miami-Dade County, where many Latina seasonal workers reside and work, has the highest incidence of the human immunodeficiency virus (HIV) in the US: a rate four times the national average. Despite this disproportionate risk for HIV, there are no HIV prevention interventions that aim to decrease HIV among Latina seasonal workers. Methods: The PROGRESO EN SALUD study compared the outcomes of two interventions adapted to include a social network component (VOICES and HEALTHY). Recruitment used a social network respondent-driven sampling design in which each seed was asked to recruit three friends, and those friends were asked to recruit three friends, for a total of twenty groups of 13 friends. We collected data at baseline, and 6 months and 12 months post intervention completion. We used generalized estimating equation models, properly adjusted for non-independent contributions of both social network interventions, to estimate the effects. Gaussian family multivariate models were calculated, addressing exchangeable working correlations, including both individual-level and cluster-level covariates in these models. Results: A total of 261 Latina seasonal workers participated in either the HEALTHY or the VOICES intervention. There were significant changes over time in cognitive factors (HIV knowledge, condom use self-efficacy, and adequate knowledge of condom use), behavioral factors (condom use, female condom use, and HIV testing), and communication factors (talking with friends about HIV prevention and intention to negotiate safe sex with male partners). Discussion: This study supports the literature suggesting that interventions incorporating social networks can have positive effects on HIV prevention and treatment outcomes, including sustained benefits beyond study periods

Engaging African Americans in Smoking Cessation Programs

African Americans are disproportionately exposed to and targeted by prosmoking advertisements, particularly menthol cigarette ads. Though African Americans begin smoking later than whites, they are less likely to quit smoking than whites. This study was designed to explore African American smoking cessation attitudes, behaviors, and resources to gain insights on how to enhance the appeal of smoking cessation interventions in African American communities. Ten focus groups were conducted with urban, suburban, and rural African American adult smokers and ex-smokers in Maryland who also completed brief questionnaires. Although knowledge of negative health effects of smoking and motivation for smoking cessation were high, participants lacked confidence in their ability to quit successfully and were poorly informed about resources and programs for smoking cessation. Findings from this study suggest that cultural tailoring, neighborhood focus, and strong marketing may enhance the appeal of smoking cessation programs to African American smokers. Programs also may be more attractive if they use respected nonsmoking role models and peer support